Coercion in Outpatients under Community Treatment Orders: A Matched Comparison Study
Open accessAbstract
OBJECTIVE: Since the deinstitutionalization of psychiatric services around the world, the scope of outpatient psychiatric care has also increased to better support treatment access and adherence. For those with serious mental illness who may lack insight into their own illness, available interventions include coercive community practices such as mandated community treatment orders (CTOs). This paper examines the perceptions of coercion among service users treated with a CTO. METHOD: = 69 in each group). Participants were interviewed using a series of questionnaires aimed at evaluating their perceptions of coercion and other aspects of the psychiatric treatment. RESULTS: The level of coercion reported by service users treated under a CTO was significantly higher than that in the comparison group. However, in adjusted analyses, service users' perception of coercion, irrespective of their CTO status, was directly correlated with their previous experience with probation and inversely correlated with the sense of procedural justice in their treatment. CONCLUSIONS: Evaluation of psychiatric service users' experiences of coercion should consider their past and current involvement with other types of coercive measures, particularly history of probation. Clinicians may be able to minimize these experiences of coercion by incorporating procedural justice principles into their practice.
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Four studies specifically reported that a lack of procedural justice heightened perceived coercion even among voluntarily admitted patients.
“Four studies specifically reported that a lack of procedural justice heightened perceived coercion even among voluntarily admitted patients [24,34,42,105].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [24]
The Introduction describes a matched comparison group of voluntary psychiatric outpatients, and the Results report that greater procedural justice was associated with lower perceived coercion irrespective of CTO status. The claim changes the setting to voluntarily admitted patients; the Discussion also says the cross-sectional design cannot establish that a lack of procedural justice heightened coercion. (LLM, conf=0.88)
Experimental — accuracy not yet measuredNumerous quantitative studies have found an inverse relationship between levels of procedural justice and levels of perceived coercion.
“Numerous quantitative studies have found an inverse relationship between levels of procedural justice and levels of perceived coercion [15,24,34,38,42,45,48,54,55,65,92,95,105,107,147,156].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [24]
Patients subjected to outpatient commitment were more likely to perceive coercion.
“Patients subjected to outpatient commitment were more likely to perceive coercion [24,57,65,92,95,107]”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [24]
More recent studies suggest that perceived coercion may be linked to procedural justice.
“Furthermore, more recent studies suggest that perceived coercion may be linked to other factors such as the perception of fairness and justice during treatment, also known as procedural justice [15,16,24,25].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [24]
In the first paper, people on CTOs reported significantly greater levels of perceived coercion in unadjusted analyses.
“In the first, people on CTOs reported significantly greater levels of perceived coercion in unadjusted analyses.”
From Canadian Studies on the Effectiveness of Community Treatment Orders: An Updated Systematic Review of Quantitative Data: Études canadiennes sur l’efficacité des ordonnances de traitement en milieu communautaire : mise à jour d’un examen systématique des données quantitatives (2025) · cites this paper as [7]
On adjusted analyses including socio-demographic factors, diagnoses and insight, individuals' perception of coercion was directly linked to their past probation experiences and inversely related to their sense of procedural justice in their treatment regardless of CTO status.
“However, on adjusted analyses including socio-demographic factors, diagnoses and insight, individuals’ perception of coercion was directly linked to their past probation experiences and inversely related to their sense of procedural justice in their treatment regardless of CTO status.”
From Canadian Studies on the Effectiveness of Community Treatment Orders: An Updated Systematic Review of Quantitative Data: Études canadiennes sur l’efficacité des ordonnances de traitement en milieu communautaire : mise à jour d’un examen systématique des données quantitatives (2025) · cites this paper as [7]
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References 38 · Cited by 19
Research works printed but not linked: 3
- [7]7. Segal SP. Assessment if outpatient commitment in randomized trials. Lancet Psychiatry. 2017;4(12):e26–e28. [DOI] [PubMed] [Google Scholar]
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- [36]36. Allison RD. Multiple regression: A primer. Thousand Oaks, CA: Pine Forge Press; 1999. [Google Scholar]
- Authors
- Nakhost, A., Sirotich, F., Pridham, K. M. F., Stergiopoulos, V., & Simpson, A. I. F.
- Affiliations
- St. Michael's Hospital (CA)
- University of Toronto (CA)
- Centre for Urban Health Solutions, St Michael Hospital, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health (CA)
- Corresponding author
- Nakhost, Arash
- Venue
- The Canadian Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2018-04-03
- Volume
- 63
- Issue
- 11
- Pages
- 757-765
- ISSN
- 0706-7437 (ISSN-L)
- 1497-0015
- PMC
- PMC6299192
- OpenAlex
- W2795614725
- Cited by
- 19
- References
- 38
- Citations by year
- 2025: 6 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 3 · 2020: 1 · 2019: 4
- FWCI
- 2.35
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Canadian Journal of Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ontario Academic Health Science Center Alternate Funding Plan Innovation Funds (SMHAIF-099)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Keywords
- community treatment orders, coercion, outpatient psychiatric care, severe mental illness, service user perceptions, procedural justice, deinstitutionalization
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